Long-term local stimulation, such as: poor oral hygiene, irregular dentition, disuse, cavity in the neck, poor tooth filling, poor restoration, food impaction, partial removable denture clasp and saddle bridge stimulation, oral breathing, malocclusion, nasal congestion, etc. Chronic inflammatory gingival hypertrophy begins with the expansion of gums and marginal gums or both. In the early days, it surrounded the tooth neck like a lifebuoy, and later it gradually increased to cover part of the crown. Generally, only the gum * or gingival margin is enlarged, which can be local or all. Progress is slow and painless, unless accompanied by acute inflammation or trauma.

Gingival changes caused by oral breathing: gingivitis and gingival hypertrophy are common in the upper anterior teeth area, and the gums may be red, swollen and edema. The exposed part is obviously separated from the unexposed normal gingiva.

2. Acute inflammatory hypertrophy

(1) Gingival abscess: Acute inflammatory gingival hypertrophy is a response to foreign body stimulation, such as toothbrush bristles, stones and shells of shrimps and mussels infiltrating into the gums. Gingival abscess is a local, painful and rapidly developing lesion, usually sudden. Generally confined to marginal gums or gums. At the initial stage, it was red and swollen, and the surface was glowing. 24 ~ 48 hours can automatically rupture, pus and purulent secretions overflow. Adjacent teeth often have knocking pain.

(2) Periodontal abscess: seen in periodontal disease, accompanied by deep periodontal pocket.

3. Drug-induced gingival hyperplasia

Drug-induced gingival hyperplasia refers to gingival fiber hyperplasia and volume increase caused by taking some drugs.

Long-term use of phenytoin sodium (Darren Ding), an antiepileptic drug, can cause gingival fibrosis with inflammation. The degree of gingival hyperplasia is obviously related to oral hygiene and the original degree of inflammation.

In recent years, many reports have pointed out that other drugs such as cyclosporine and nifedipine can also cause drug-induced gingival hyperplasia. Cyclosporine is an immunosuppressant, which is often used for organ transplantation or some patients with autoimmune diseases.

Although local stimulation is not the primary factor of drug-induced gingival hyperplasia, gingivitis caused by plaque, dental calculus and food impaction can accelerate the development of the disease.

Generally, the gingival hyperplasia caused by phenytoin sodium begins at 1 ~ 6 months after taking the drug, and the hyperplasia begins at the labial or lingual gingiva and marginal gingiva, and protrudes from the gingival surface in a small ball shape. Then, the proliferating * continues to grow and is close to or connected with each other, covering part of the tooth surface, and when it is serious, it spreads to the attached gum, which makes the appearance of the gum change obviously. Gum * can be spherical or nodular, and sometimes it is mulberry-like hyperplasia. In severe cases, it can proliferate to the incisal margin or face, or even completely cover the crown, which hinders chewing function and affects aesthetics and oral hygiene. Gingival tissue hyperplasia is tough, slightly elastic, pale pink, and generally not easy to bleed. No local symptoms and pain. Gingival sulcus is deepened due to gingival swelling, and the gums lose their physiological shape and lack self-cleaning function. Gingival hyperplasia will affect the closure of lips, cause oral breathing, and dental plaque is easy to accumulate. Therefore, most patients have varying degrees of gingival inflammation. At this time, the gums are dark red or purplish red, and the gingival margin is prone to bleeding. Hyperplasia gums often squeeze displaced teeth, especially in the upper anterior teeth area.

Drug-induced gingival hyperplasia often occurs in the whole gum, but the upper and lower anterior teeth are heavier. It only occurs in the dentate area, and the hyperplastic gingival tissue can disappear by itself after tooth extraction.

4. Gingival fibromatosis

Hereditary gingival fibromatosis is also called familial or spontaneous gingival fibromatosis. It is diffuse fibrous hyperplasia of gingival tissue. Can a patient have a family history?

The disease can occur earlier than childhood or after the eruption of deciduous teeth, and generally begins after the eruption of permanent teeth. Gingival hyperplasia is extensive and gradual, which can involve the gingival margin, gum * and attached gum of the whole mouth, and even reach the junction of membrane and gum, especially the palatal side of maxillary molar. Gingival hyperplasia can cover part or all of the crown, hinder chewing, and teeth often shift. Hyperplasia gums are normal in color, tough in tissue, smooth in appearance, sometimes nodular, with obvious stippling, and not easy to bleed. Because the gums become thicker, it is sometimes difficult to erupt teeth.

5. gingivitis during pregnancy

Gingivitis during pregnancy means that during pregnancy, due to the increase of female hormone level, the original chronic inflammation of the gums is aggravated, the gums swell or form gingivoma-like changes, and the postpartum lesions can be alleviated or subsided by themselves. The occurrence of gingivitis during pregnancy is related to oral hygiene, and the incidence of good oral hygiene is low.

Patients usually have gingivitis of different degrees before pregnancy, and obvious symptoms begin to appear at 2 ~ 3 months after pregnancy, reaching the peak at 8 months, which is consistent with the level of progesterone in blood. About 2 months after delivery, gingivitis can return to the pre-pregnancy level.

Gingivitis during pregnancy can occur in a few teeth or the whole gums, especially in the anterior teeth area. Gingival margin and gum * bright red or cyanotic, soft and shiny. Obvious inflammatory swelling, hypertrophy, gingival pocket formation, easy to bleed when probing lightly, and easy to bleed when patients suck or eat, which is often the chief complaint symptom when seeing a doctor. Generally there is no pain. In severe cases, ulcers and pseudomembranes can be formed at the gingival margin, and there is mild pain.

During pregnancy, gingival tumors usually occur in the interdental area of a single tooth, especially in the labial side of the anterior teeth, and often occur in the interdental area of individual dentition or gouging. It usually occurs in the fourth to sixth month of pregnancy, and it increases rapidly, with bright red or deep purple color, soft texture, smooth surface and easy bleeding. Tumors often extend from near to far, and some cases are lobulated, pedicled or sessile. Generally, the diameter is less than 2cm, and only serious cases will be infected because the tumor is too big to prevent eating or being bitten. Patients often go to see a doctor because of bleeding and eating disorders. After delivery, the pregnancy gum tumor can gradually shrink by itself, but it can only disappear after removing local irritants, and some patients need surgery.

6. Teenage gingivitis

Puberty gingivitis refers to chronic nonspecific gingivitis occurring in adolescence, which can occur in both men and women, but it is slightly more common in women. Because of the obvious changes in endocrine, especially sex hormones, gingiva is the target tissue of sex hormones. When endocrine changes, gingival tissue will produce obvious inflammatory response to a small amount of local stimulation.

Puberty gingivitis mainly occurs in the labial margin and gingival margin of anterior teeth, and rarely occurs on the lingual side. The labial gingival margin and gingival margin are obviously swollen, * often spherical, and the gingival color is dark red or bright red, which is bright and soft. The gingival sulcus can deepen to form a gingival pocket, but the adhesion level remains unchanged, which makes it easy to bleed during exploration. Patients generally have no obvious symptoms, or bleeding and bad breath when brushing their teeth or biting hard objects.

7. Gingival lesions of leukemia

Leukemia is a malignant blood disease. Gingival swelling occurs in leukemia, the most common ones are acute monocytic leukemia and acute myeloid leukemia, and it can also be seen in acute lymphoblastic leukemia. Because of gingival swelling and bleeding, patients often go to stomatology first. Many leukemia patients are first discovered by dentists before other obvious symptoms appear, which requires dentists to correctly identify, diagnose early and avoid misdiagnosis.

Leukemia gingival swelling can spread to interdental *, marginal gingiva and attached gingiva. The gum is pale or dark red cyanosis, the tissue is soft and fragile, the surface is smooth, and the gum swelling is often the whole mouth, which can cover part of the tooth surface. Due to gingival swelling, plaque accumulation, infiltration and accumulation of a large number of immature white blood cells, peripheral vascular embolism and other reasons, the gingival margin tissue is necrotic, ulcerated and covered with false membrane, which looks like necrotizing gingivitis, and in severe cases, necrosis is widespread. Bad breath, obvious bleeding tendency of gums, frequent bleeding at the gingival margin, which is difficult to stop, and bleeding spots or ecchymosis can be seen on gums and oral mucosa. Patients often go to the stomatology department first because of gingival swelling, pain, bleeding or necrosis. Checking the blood picture in time is helpful for diagnosis! In severe cases, oral mucosal necrosis or severe toothache, fever, local lymph node enlargement, fatigue, anemia and other symptoms may also occur.

8. Gingivoma

Gingivoma is an inflammatory tumor-like growth that occurs in the gums. It comes from the connective tissue of periodontal ligament and gum. Because it has no biological characteristics and structure of tumor, it is not a real tumor, but it is easy to recur after resection.

The clinical manifestations are mostly female patients, especially young people. Most of them occur in the gum * on the labial and buccal side, and rarely in the lingual and palatal side, which is a single tooth. The mass is spherical or oval, with different sizes, generally ranging from a few millimeters to 1 ~ 2 cm in diameter, and sometimes lobulated. The mass can be pedicled, such as polypoid, or sessile, with a wide base. Generally, it grows slowly. Larger lumps may be bitten, leading to ulcers or infections. Larger masses can also destroy the alveolar bone wall, and X-ray films can show bone absorption and widening of periodontal ligament space. Teeth may loosen and shift.